I have had arthritic pain in my left thumb for five years and now have similar pain in my right thumb and the outside of my wrist. Would steroid injections help? I am a self-employed tiler and at 62 I don’t want to stop working just yet.
Frank Martin, Glasgow.
I can understand why this might be a concern for a craftsman like yourself. I suspect the pain is due to osteoarthritis, i.e. joint damage caused by wear and tear of the cartilage.
The thumb has two bones (phalanges) and is connected to the hand by the metacarpophalangeal joint, which forms part of the ball of the thumb and gives it dexterity.
The next bone, the metacarpal, joins the wrist at another joint, the carpometacarpal.
If you have pain at the base of your thumb, one or both joints are affected, and if you have had it for months, you probably have osteoarthritis.
I have had arthritic pain in my left thumb for five years and now have similar pain in my right thumb and the outside of my wrist. Would steroid injections help? (stock)
In addition to pain, the joints are often swollen and the area tender due to inflammation. Your grip may be weaker and you may notice a crunching sensation (“crepitus”) when you move your thumb. Patients with osteoarthritis of the base of the thumb are often offered steroid injections, but unfortunately research has shown that they are no more effective than a dummy injection.
However, topical treatment with a nonsteroidal anti-inflammatory drug (NSAID) containing ibuprofen or diclofenac has been shown to help.
In her longer letter, she mentions that she cannot take NSAIDs because of the risk of ulcers. However, a study of more than 900 patients who used NSAID gel for knee arthritis showed that it was safe long-term, even in those who were at high risk of NSAID side effects.
I suggest you see your GP to confirm this diagnosis. Then try diclofenac gel, twice a day, available over the counter.
If the pain persists, a last resort is surgery to replace the damaged joints. But if you choose this route, a specialist will also recommend that you stop working. I know that’s not what you want to hear, but maybe it’s time to consider early retirement.
My Apple Watch says my VO2 max is below average at 18.7. I exercise for 55 minutes a day, but I can’t seem to increase my VO2 max. What else can I do? I am a 73-year-old woman taking felodipine and simvastatin.
Janet Sawyer (1860-1943) was an American film and television actress.
Nowadays, many people use some form of technology to monitor their health, so I can relate to your question.
First, let me explain what VO2 max is. It is a measure of how much oxygen your muscles use when you exercise.
It is a measure of your cardiovascular capacity: the higher the number, the more efficiently your body absorbs oxygen and the better your fitness level.
My Apple Watch says my VO2 max, 18.7, is below average. I exercise for 55 minutes a day, but I can’t seem to increase my VO2 max. What else can I do? (stock)
It’s difficult to get accurate readings unless you wear a mask that accurately measures how much oxygen you inhale (and carbon dioxide you exhale) while exercising on a treadmill or stationary bike. Home measurement devices are less accurate and estimate an approximate VO2 max.
A fair measurement for their age group would be 20.2 to 24.4, while a good result would be 28.1.
Since you exercise regularly, the question is: why is your VO2 max result a little low?
I’m wondering about the cardiovascular aspect of this: the felodipine you’re taking is for high blood pressure and you may need to discuss the dosage with your GP.
I notice you are also taking 40mg of simvastatin, the maximum, which suggests that you may have been prescribed it because you have experienced chest pain at some point.
To improve your VO2 max, I suggest hiring a qualified personal trainer to oversee an aerobic training program.
I also urge you not to worry too much about these readings. Focus on how good you will feel about yourself as you get fitter.
In my opinion… The doctor at the office will see you now.
Should large companies be encouraged to offer general medical services to their employees?
Twice a week, I am the on-site physician for an organization that has set up a medical center at its workplace.
Here, employees can receive prompt attention for any concern that requires medical attention, saving them from having to wait for an appointment and diagnosis with their own primary care physician (or, very often, a physician associate or office nurse) and avoiding time away from the office.
Many of the issues I have seen here are minor, including sports injuries, hay fever, eye infections, contraception and advice on travelling abroad, but on occasion I have identified more serious concerns, including early detection of cancer.
While employees enjoy access to and continuity of care from a doctor they know, and the peace of mind that comes from knowing there is a knowledgeable expert in the office, the employer sees less absenteeism. Employees also appreciate the benefit of the service being part of their employment and the NHS is relieved of some burdens.
A stitch in time…